Enrollments Rise on State Health Exchanges

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By Gerald B. Silverman, Adrianne Appel, Laura Mahoney, Tripp Baltz and Paul Shukovsky

Enrollment increased in a number of state health exchanges for 2017, but it’s unclear if the numbers reflect a response to the expected repeal of the Affordable Care Act.

According to a Bloomberg BNA analysis of data from six states, enrollments increased in California, Colorado, Massachusetts, New York and Washington. Maryland, while facing a last minute surge in enrollment, experienced a decline from 2016.

A number of states experienced last-minute surges and some extended their deadlines for signing up.

The numbers from state exchanges contrast with 2017 enrollment on HealthCare.gov, the federal website where people in states that do not run their own exchanges sign up for coverage. About 400,000 fewer people signed up in the 39 states that use the federal exchange, according to a preliminary report released Feb. 3.

New York

The New York exchange experienced a dramatic increase in enrollment, jumping by 28 percent from 2.8 million in 2016 to 3.6 million in 2017, according to NY State of Health. The enrollment numbers include those who used the exchange to sign up for qualified health plans, Medicaid, Child Health Plus and the state’s Essential Plan.

New York had a surge in the last two days of open enrollment, with 45,807 people signing up for coverage, according to the exchange. Jan. 31 was the single busiest day for the state website, which had 3 million page-views and was used by more than 110,000 visitors.

NY State of Health’s customer service center received more than 100,000 calls on the final day of open enrollment, according to the exchange.

Donna Frescatore, executive director of the exchange, said it’s difficult to determine what’s driving the enrollment numbers and whether or not the expected repeal of the ACA is a factor. “During the application process, we don’t ask any specific questions,” she told Bloomberg BNA.

One factor driving enrollment, however, is the “tremendous growth” in New York’s basic health plan option, Frescatore said. The plan, which is known as the Essential Plan, provides a low-cost option for low-income New Yorkers. She said enrollment increased by about 75 percent to 665,324 in 2017.

Bill Hammond, director of health policy at the Empire Center, a conservative Albany-based think tank, said the enrollment numbers in New York are somewhat misleading and overstated.

He said the state includes people who enrolled in Medicaid through the exchange, but it fails to adjust the number to account for an overall decline in Medicaid enrollment. Hammond told Bloomberg BNA that, when adjusted, the increase in enrollment under the state health exchange is in “the low single-digits.”

“It’s a little hard to read,” he said, referring to the factors influencing enrollment. “It’s really hard to link a particular enrollment outcome to a political development because people are so confused.”


Uncertainty about the future of the ACA didn’t appear to weaken enrollment demand in California, with the state’s health benefits exchange gaining 368,000 enrollees during the open enrollment period that ended Jan. 31.

With the increase, Covered California is providing insurance to more than 1.5 million people, the exchange said Feb. 6. More than 50,000 people signed up in the final two days of open enrollment.

Executive Director Peter V. Lee said the exchange met its enrollment projections despite uncertainty as congressional Republicans debate how to repeal the ACA. He pointed to survey research the exchange commissioned after Donald J. Trump won the presidential election that showed political uncertainty about the ACA was a concern for consumers, but concern didn’t stop them from enrolling.

“This high number of sign-ups validates the surveying we did after the election,” Lee said in a news release. “When consumers know they have a pathway to get health care made affordable by tax credits, they sign up.”

About 412,000 people signed up and selected a health plan, but the expected number of people who enroll and pay their premiums will be closer to 368,000, Covered California spokesman James Scullary told Bloomberg BNA. Each year, thousands of people select a plan but don’t enroll for various reasons, such as getting coverage through work, changing their minds, failing to pay premiums or qualifying for Medicaid instead.

Covered California will know how many of its 1.2 million existing consumers renewed for 2017 in March, but early indications are that they are continuing coverage, Lee said.

Separately, about 5 million Californians now receive health care through the state’s expansion of Medicaid under the ACA, according to the California Department of Finance.


Sign-ups on Washington state’s exchange increased by 13 percent over 2016 to 225,595 people.

Traffic to the exchange’s website spiked in the last week of open enrollment with almost 500,000 unique visitors to the site, according to the exchange. The state’s Healthplanfinder’s call center got more than 44,000 calls in the week before the enrollment deadline.

“We do not have any hard evidence connecting the increase in sign-ups to a purported repeal of the ACA,’’ exchange spokesman Ben Spradling told Bloomberg BNA.

“Given that it has been a consistent talking point on both the local and national level, it has likely helped keep open enrollment at the forefront of customers’ minds,” he said. “But we cannot directly tie the issue with the increase we experienced.”


Enrollment on Colorado’s exchange hit 176,000 this year, an increase of 12 percent over 2016, according to the exchange.

A surge in last-minute sign-ups for 2017 spurred the exchange to give consumers three additional days to complete the process. Individuals who began the process by midnight Jan. 31, the original deadline, were given an extension to Feb. 3, Luke Clarke, spokesman for Connect for Health Colorado, told Bloomberg BNA.

Enrollees whose health plan dropped out of the exchange in 2016 have until March 1 to enroll, he said.

Joe Hanel, a spokesman for the Colorado Health Institute, a health-policy think tank in Denver, told Bloomberg BNA that he has heard anecdotally that the national dialogue about ACA repeal has been a mixed bag for enrollment.

“Some people are rushing to sign up, while others have been discouraged from enrolling,” he said.


Enrollment in the Massachusetts exchange increased 6 percent from 233,536 in 2016 to 246,831 this year, according to the exchange.

About 50,000 new members signed up for a plan through the Commonwealth Health Connector, the state’s health-care exchange, during open enrollment. This compares to 36,000 new enrollees during 2016 open enrollment.

Many people were concerned about premiums and cost-sharing rising this year and switched to a different plan, Connector spokesman Jason Lefferts told Bloomberg BNA in an email. About 64,000 people switched plans, he said.

“We spent a lot of time talking to people about the importance of shopping with the prospect of members facing high premium increases,” Lefferts said. “We typically see 3-7 percent of members switch, so that was a lot more than usual.”

The exchange’s call center received 345,621 calls during open enrollment, compared with 243,619 during open enrollment in 2016.


Maryland’s exchange enrolled 157,637 in private health plans in 2017, a decline of 3 percent from last year, according to the exchange.

Maryland also allows individuals to enroll in Medicaid through the exchange. Medicaid enrollment declined by 5 percent from 362,415 in 2016 to 343,542 this year.

Despite the decline in enrollment, the Maryland Health Connection call center received a record number of calls in a single day on Jan. 31, with more than 20,500 people calling in. Traffic on MarylandHealthConnection.gov also peaked, with more than 117,000 page views and 56,000 visits.

To contact the reporters on this story: Gerald B. Silverman in Albany, N.Y., at GSilverman@bna.com; Adrianne Appel in Boston at aappel@bna.com; Laura Mahoney in Sacramento, Calif., at lmahoney@bna.com; Tripp Baltz in Denver at abaltz@bna.com; and Paul Shukovsky in Seattle at Pshukovsky@bna.com

To contact the editor responsible for this story: Brian Broderick at bbroderick@bna.com

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